INTRAOCULAR PRESSURE AFTER PHACOEMULSIFICATION USING HYDROXYPROPYL METHYLCELLULOSE AND SODIUM HYALURONATE AS VISCOELASTICS
Abstract
Background: Phacoemulsification and intraocular lens (IOL) implantation has resulted in earlyvisual rehabilitation, increased wound stability and improved refractive results. Viscoelasticsubstances (VES) are important adjuncts in this type of surgery. Use of VES inphacoemulsification can be associated with adverse effects, the most common and potentiallydangerous of which is the transient rise in intraocular pressure (IOP) in post-operative period. Toevaluate the effects of viscoelastic substances on post-operative IOP after phacoemuls ificationwith implantation of intraocular lens, a cross-sectional comparative, prospective study wasconducted in the department of Ophthalmology, Combined Military Hospital, Peshawar, Pakistan,from October 2003 to March 2004. Methods: One hundred patients were randomized into twogroups of 50 each. Phacoemulsification with implantation of intraocular lens was performed in allthe patients. 2% Hydroxypropyl Methylcellulose (HPMC) was used in one group and 1% SodiumHyaluronate (NaHa) was used in the other group. IOP was measured pre-operatively as well as 24hours and 7 days post-operatively. Results: There was no significant difference in the preoperative intraocular pressure between the two groups (p=0.483). Twenty four hours after surgery,the mean IOP increased by 2.84±SD 2.12 mm Hg in 2% Hydroxypropyl Methylcellulose groupand 4.54±2.07 mm Hg in 1% Sodium Hyaluronate group. The increase was significantly higher in1% Sodium Hyaluronate group as compared to 2% Hydroxypropyl Methylcellulose group(p=0.003). Seven days after surgery the mean intraocular pressure returned to near pre-operativelevels in both the groups. Conclusion: Sodium Hyaluronate causes significantly higher increasein intraocular pressure in early post-operative period after cataract surgery inspite of maximumaspiration of viscoelastic substance from the eye following phacoemulsification surgery.Key Words: Intraocular pressure, Methylcellulose, Sodium Hyaluronate, Phacoemulsification,Viscoelastic substance.References
Tarin SA. Viscoelastic substances: properties and uses in
anterior segment surgery. Pakistan J Ophthalmol.
;12(1):22-6.
Madhavan HN, Roy S. Effects of viscoelastic ophthalmic
solutions on cell cultures. Indian J Ophthalmol.
;46(1):37-40.
Maar N, Graebe A, Schild G, Stur M, Amon M. Influence of
viscoelastic substances used in cataract surgery on corneal
metabolism and endothelial morphology: comparison of
Healon and Viscoat. J Cataract Refract Surg.
;27(11):1756-61.
Arshinoff SA. Dispersive-cohesive viscoelastic soft shell
technique. J Cataract Refract Surg. 1999;25(2):167-73.
Arshinoff SA, Albiani DA, Laporte JT. Intraocular pressure
after bilateral cataract surgery using Healon, Healon 5, and
Healon GV. J Cataract Refract Surg 2002;28(4):617-25
Rainer G, Menapace R, Findl O, Kiss B, Petternel V,
Georgopoulos M, et al. Intraocular pressure rise after small
incision cataract surgery: a randomized intraindividual
comparison of two dispersive viscoelastic agents. Br J
Ophthalmol 2001;85(2):139-42.
Jone DT, Karp CL, Heigle TJ. Principles and techniques of
cataract surgery phacoemulsification: Methodology and
complications. In: Albert DM, Robinson NL, Barney NP,
Brightbill FS, Clayman HM, Kaufman PL, et al, eds.
Ophthalmic surgery: Principles and techniques. USA:
Blackwell Science, Inc; 1999: 283-312.
Mckellar MJ, Elder MJ. The early complications of cataract
surgery: is routine review of patients 1 week after cataract
extraction necessary?
Ophthalmology. 2001 May;108(5):930-5.
Morgan RK, Sk uta GL. Viscoelastic-related glaucomas.
Semin Ophthalmol. 1994; 9(4):229-34.
Harooni M, Freilich JM, Abelson M, Refojo M. Efficacy of
hyaluronidase in reducing increases in intraocular pressure
related to the use of viscoelastic substances. Arch Ophthalmol.
;116(9):1218-21
Rainer G, Menapace R, Findl O, Georgopoulos M, Kiss B,
Petternel V. Intraocular pressure after small incision cataract
surgery with Healon 5 and Viscoat. J Cataract Refract Surg.
; 26(2):271-6.
Ahmed II, Kranemann C, Chipman M, Malam F. Revisiting
early postoperative follow-up after phacoemulsification. J
Cataract Refract Surg. 2002;28(1):100-8.
Luchtenberg M, Luchtenberg C, Lang M, Badachschi N ,
Emmerich KH. Intraocular pressure response after
administration of 3 different viscoelastic agents after cataract
operation. Ophthalmologe. 2000;97(5):331-5
Jürgens I, Matheu A, Castilla M . Ocular hypertension after
cataract surgery: a comparison of three surgical techniques
and two viscoelastics. Ophthalmic Surg Lasers.
;28(1):30-6
Holzer MP, Tetz MR, Auffarth GU, Welt R, Völcker HE.
Effect of Healon 5 and 4 other viscoelastic substances on
intraocular pressure and endothelium after cataract surgery. J
Cataract Refract Surg. 2001;27(2):213-8.
Kohnen T, von Ehr M, Schütte E, Koch DD. Evaluation of
intraocular pressure with Healon and Healon GV in sutureless
cataract surgery with foldable lens implantation. J Cataract
Refract Surg 1996; 22(2):227-37
Hazariwala K, Mortimer CB, Slomovic AR. Comparison of
% Hydroxypropyl methylcellulose and 1% Sodium
hyaluronate in implant surgery. Can J Ophthalmol 1988;
(6):259-61.
Mac Rae SM, Edelhauser HF, Hyndiuk RA, Burd EM, Schultz
RO. The effects of Sodium Hyaluronate, Chondroitin sulfate,
and Methylcellulose on the corneal endothelium and
intraocular pressure. Am J Ophthalmol. 1983; 95(3): 332-41
Liesegang TJ, Bourne WM, Ilstrup DM. The use of
hydroxypropyl methylcellulose in extracapsular cataract
extraction with intraocular lens implantation. Am J
Ophthalmol. 1986; 102(6):723-6.
Junejo SA, Laghari NA. Analysis of short -term effect of two
viscoelastic agents on intraocular pressure after extracapsular
cataract extraction and posterior chamber lens implantation.
Pakistan J Ophthalmol 1996; 12(2):64-5.
Junejo SA, Khan SA. Incidence of glaucoma in
pseudoaphakia and its management. J Coll Physicians Surg
Pak. 1996; 6:309-12.
Wedrich A, Menapace R. Intraocular pressure following
small-incision cataract surgery and poly HEMA posterior
chamber lens implantation. A comparison between
acetylcholine and carbachol. J Cataract Refract Surg 1992;
(5):500-5.
Jacobi PC, Engels B, Dietlein TS, Krieglstein GK. Effect of
trabecular aspiration on early intraocular pressure rise after
cataract surgery. J Cataract Refract Surg. 1997; 23(6):923-9.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
